Even if you have only the slightest suspicion that you may have a problem with skin cancer, this Entry is aimed at encouraging you to see a doctor. Too many people put it off... and then keep putting it off.
What to Look Out For
Any area of skin that looks different from its surroundings, that grows or itches, whether continually or intermittently, is cause for investigation. Even moles that have been present for a long time can start to change, and those changes are hints that perhaps something unpleasant is happening and you should see a doctor.
If you do have an abnormal area of skin and it does turn out to be cancerous, then the treatment will certainly cause some degree of discomfort, depending on the cancer type and the extent of its development - but consider that such discomfort is nothing to what will ensue if the condition is not treated. Skin cancer is no more pleasant than any other sort; however, when caught early enough, skin cancer is rarely cause for any great concern.
Three Types of Skin Cancer
The three commonest types of skin cancer are melanoma, squamous cell carcinoma and basal cell carcinoma. These can all be fatally dangerous if neglected, but none is too serious if caught in time.
There is also a condition known as 'pre-cancer', called keratosis (usually actinic keratosis) which can develop into cancer if left untreated.
Unlike the squamous cell and basal cell carcinomas, melanomas spread. In medical terms, 'spreading' means that it doesn't just get bigger but finds its way into the bloodstream and thereafter can pop up anew just about anywhere. Treatment is surgical, similar to that for the squamous and basal cell carcinomas described below.
I have no personal experience of melanoma, thankfully.
Squamous Cell Carcinoma
Squamous cell carcinomas do not normally spread. Treatment for squamous cell carcinoma is usually surgical.
In this one case, a tiny pinprick became evident, on the left temple, that attracted the fingers and felt for all the world as if a small splinter had found its way into the skin. It was barely visible, just a tiny whitish spot. It grew slowly, over a couple of months, to about a millimetre across; and then two - by which time it looked a little like a soft pinkish wart and was sore to the touch.
Family problems around that time (frequent visits to aged parents, living some 250 miles away is my excuse) meant that I neglected to do anything about it for some time - until it was nearly three millimetres in diameter.
By the time it was treated it needed a piece cut out that was three to four times its diameter and of commensurate depth - though not, thankfully, the same depth as diameter! - and the surgeon stretched and stitched the skin around it in order to cover the wound. Of course, if I had done something earlier, when the carcinoma was smaller, the excision would have been a quarter (or less) the size of the one eventually required and the healing process would have been much less awkward.
Discomfort from the wound was, for the most part, mild. Though I sleep mostly on my back, I do turn occasionally. Naturally, after a few nights, I learned not to turn onto my left side without waking first.
A week or so after the operation the wound became infected. It was easily and quickly treated and I stopped trying to shower without wetting above the shoulder. Strip-washes became the order of the day. It took a few weeks to heal to a reasonable state where careful showering became feasible.
The infection was most probably due to not being careful enough in the shower. The adhesive dressings stuck well enough to my hair, but not at all well to the skin underneath. In retrospect a (very) short haircut and a shave around the bad patch would have been a good idea. I then considered shaving the area but didn't, being afraid of getting hair into the wound, and the possibility of further infection.
Basal Cell Carcinoma
Basal cell carcinomas do not normally spread. Treatment for basal cell carcinoma is often surgical but if caught early enough cryosurgery - a technique for freezing and killing abnormal cells - may be used (see pre-cancer below).
These were nearly flat areas that itched slightly and formed a crust that wiped off fairly easily. With time, they grew, itched more and formed a firmer crust. Again, I neglected these areas of skin for too long and for the same reasons (parents into and then out of hospital, setting up home care for them and so on).
There were four such areas, treated a few months after the squamous cell carcinoma: one behind my left ear, two on the left upper back and one on the right upper back. Similar treatment was given for these as for the squamous variety, that being excision, except for one, which was curetted instead (a sort of scraping scoop with a tool a bit like a sharp, shallow spoon).
Again, mainly mild discomfort ensued from the wounds themselves, but this time sleeping was more of a problem, though not as bad as anticipated. I found I could shift from half-on-back, half-on-shoulder on one side, over to the other without damage. It did mean coming awake each time but that was - and had to be - acceptable.
The length of time spent healing was several weeks as it felt necessary to allow the healing to progress a fair way before I gained enough confidence to stop worrying about knocks and scrapes to my back. Also strip-washing again... it felt as though it would never end!
Treatment is normally one of the following:
By cream containing fluorouracil which kills the bad cells which then fall away. The treated skin will probably become reddened during treatment and for perhaps a week or so after.
By cryosurgery, where liquid nitrogen is carefully applied, resulting in a blister that, when healed, carries the bad patch away with the dead skin. Some temporary reddening of the surrounding skin is to be expected. Of course, if at all possible, these blisters should not be burst.
Larger areas are usually treated by cryosurgery. If the area is of a sufficient size, this can leave marks, as the cold will penetrate further and cause deeper blisters. Smaller areas will probably be treated by the application of the cream, once or twice a day for two to four weeks. Here, 'large' and 'small' have as much to do with depth as with surface area - a broad, shallow area may be treated with the cream where a rather smaller area could extend deeper and need cryosurgery.
This condition showed itself as many tiny flakes of skin that didn't scratch off - or did, but not permanently. Some grew, very slowly. These areas were not dissimilar to the scabs that form after, say, a small abrasion; but they were paler, didn't heal and, after some time, became mildly irritable.
The 'larger' patches were treated by cryosurgery and the 'smaller' with fluorouracil cream. Most, if not all of these were present prior to the treatments described above, involving excisions and curetting and the surgeon didn't want to treat them until healing of the excisions was satisfactory and the treatment pronounced successful. Said he: 'That's enough for you to cope with for the present.'
At the time of writing, some 12 months after the last treatments (of the basal cell carcinomas), a further patch has appeared, with one similarity to the squamous cell carcinoma in that it started with a pinprick like a tiny splinter that seemed to catch on my t-shirt (it's on the right shoulder blade). It then went away for a few months during the denouement of my family problems, to reappear as a pale patch a couple of millimetres across that didn't heal.
It grew slowly and darkened into... How to describe it?... Imagine a moderate to bad graze, nearly healed and with a healthy scar formed. Now scrape off the scar and let it heal for a day or so while a new scar starts to form. It was dark in colour and bled a little if disturbed. That's the nearest I can get.
Mostly, I didn't know it was there, but at times it felt as if it ought to be a big blackhead that needed squeezing. My doctor said he couldn't see any of the toell-tale signs of cancer but referred me to the specialist - to be safe, and because of my history.
A week or so after I visited the doctor Murphy's law came into force - it pretty much healed over, taking about a week to do so, leaving a dark area and still making itself known occasionally.
The specialist thought it looked like a basal cell carcinoma and gave it a few squirts with liquid nitrogen. He must have enjoyed that, because he went on to treat another ten areas on my back and shoulder - all but one ascribed to keratosis. The tenth was a small lump on my scalp (I'm bald) that looked and felt like a pimple but hadn't come to a head for a few weeks. 'Probably sun damage - do you want me to squirt it?' Well... not those exact words.
The appointment ended with the doctor saying that it's likely to be an ongoing thing - he'll want to see me every six months...
Update, Nearly a Year On
Finally, to illustrate the ongoing problems of skin cancers due to sun damage, the following may be worth noting:
Since this article was published, I have had two routine, six-monthly check-ups:
One in the middle of 2007, when the doctor treated a patch on the back of my hand, that looked like a keratosis, with liquid nitrogen. This had been present at the previous treatment session - but had not responded to the fluorouracil cream.
The second check-up was at the end of the year, when he treated three 'new' basal cell carcinomas on my back - again with liquid nitrogen.
Since then, I've noticed a dry patch on the back of the other hand - small and slight, perhaps, but not to be ignored for very long.
The above treated instances were ascribed to sun damage, so take heed and be alert for abnormal patches or areas of skin that are changing. Long sleeves and a wide-brimmed hat are advisable: apparently, Australians recommend a four-inch brim - now that is wide!
It seems that you can be susceptible to these conditions even if your skin isn't pale, your eyes not blue and hair not red or light, which are the classic pointers to susceptibility.
This is a personal account and I'm not a medic - your symptoms may not be like these - but do, please, keep a wary eye out for any abnormal-looking/feeling areas of skin. Try to keep your children protected from the sun (ideally, out of it entirely).
Interestingly, four to five decades ago (with no problems in between), the received wisdom in the Navy had been: 'Get out into the sun, lad, after being cooped up in this tin can for all that time.' No doubt that didn't help - and neither did the 'bronzy-bronzy' time in later years - no longer!